Carboplatin-induced renal salt-wasting syndrome in pediatric patients with intracranial germ cell tumors and concomitant diabetes insipidus.

We report a case series of 14 children with intracranial germ cell tumor and concomitant central diabetes insipidus, who developed hyponatremia secondary to renal salt-wasting syndrome (RSWS) following the administration of carboplatin. Clinicians prescribing platinum-based chemotherapy for this group of patients should be alert to the risk of RSWS. Regular monitoring should be performed as hyponatremia can be asymptomatic until it is severe.

A Prospective, Cohort Study of the Effect of Acute and Chronic Malnutrition on Length of Stay in Children Having Surgery in Rwanda.

BACKGROUND: Malnutrition is common in pediatric surgical patients, but there are little data from low-income countries that estimate the association of malnutrition with surgical outcomes. We aimed to determine the prevalence of malnutrition and its association with length of stay (LOS) among pediatric surgical patients in Kigali, Rwanda. METHODS: We conducted a prospective observational cohort study. We enrolled surgical patients between 1 month and 15 years of age. We measured the association of acute malnutrition (wasting) and chronic malnutrition (stunting) with postoperative LOS using log-gamma regression to account for the skewed LOS distribution. Adjustment was made for sex, age, elective versus emergency surgery, household income, and American Society of Anesthesiologists (ASA) classification. RESULTS: Of 593 children, 124 children (21.2%) had acute malnutrition (wasting) with 39 (6.6%) severely wasted. A total of 160 (26.9%) children had chronic malnutrition (stunting), with 81 (13.7%) severely stunted. Median (interquartile range [IQR]) LOS after surgery was 2 (1-5) days for children with mild/no wasting, 6 (2.5-12.5) days for children with moderate wasting, and 6 (2-15) days with severe wasting. Median (IQR) LOS after surgery was 2 (1-6) days for children with mild/no stunting, 3 (1-3) days for children with moderate stunting, and 5 (2.3-11.8) days with severe stunting malnutrition. After adjustment for confounders, the moderate wasting was associated with increased LOS, with ratio of means (RoM), 1.6; 95% confidence interval [CI], 1.3-2.0; P < .0001. Severe wasting was not associated with increased LOS (RoM, 1.3; 95% CI, 0.9-1.7; P = .12). Severe, but not moderate, stunting was associated with increased LOS (RoM, 1.9; 1.5-2.4; P < .0001). CONCLUSIONS: Malnutrition is prevalent in >20% of children presenting for surgery and associated with increased LOS after surgery, even after accounting for individual and family-level confounders. Although some aspects of malnutrition may relate to the surgical condition, severe malnutrition may represent a modifiable social risk factor that could be targeted to improve postoperative outcomes and resource use. Severely stunted children should be identified as at risk of having delayed recovery after surgery.

Association of sickle cell disease with anthropometric indices among under-five children: evidence from 2018 Nigeria Demographic and Health Survey.

BACKGROUND: Malnutrition continues to affect under-five children in Africa to an overwhelming proportion. The situation is further compounded by the burden of sickle cell disease (SCD). However, association of SCD with stunting, wasting, and underweight in a nationally representative sample of under-five children remains unexplored. We aimed to describe prevalence of undernutrition by sickle cell status, to evaluate its association with growth faltering ascertained by anthropometric indices, and to explore mediating role of hemoglobin. METHODS: We availed data from the 2018 Nigeria Demographic and Health Survey (DHS) and the sample comprised 11,233 children aged 6-59 months who were successfully genotyped for SCD. The DHS employed a two-stage, stratified sampling strategy. SickleSCAN rapid diagnostic test was used for SCD genotyping. Z-scores of length/height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ) were computed against the 2006 World Health Organization Child Growth Standards. We fitted logistic regression models to evaluate association of SCD with stunting, wasting, and underweight. Mediation analysis was performed to capture the indirect effect of and proportion of total effect mediated through hemoglobin level in SCD-anthropometric indices association. RESULTS: Prevalences of stunting, wasting, and underweight among children with SCD were 55.4% (54.5-56.4), 9.1% (8.6-9.7), and 38.9% (38.0-39.8), respectively. The odds of stunting were 2.39 times higher (adjusted odds ratio (aOR) 2.39, 95% CI: 1.26-4.54) among sickle children than those with normal hemoglobin. SCD was also significantly associated with underweight (aOR 2.64, 95% CI: 1.25-5.98), but not with wasting (aOR: 1.60, 95% CI 0.85-3.02). Association of SCD with all three anthropometric indices was significantly mediated through hemoglobin level: for SCD-HAZ, the adjusted indirect effect (aIE) was - 0.328 (95% CI: - 0.387, - 0.270); for SCD-WHZ, the aIE was - 0.080 (95% CI: - 0.114, - 0.050); and for SCD-WAZ, the aIE was - 0.245 (95% CI: - 0.291, - 0.200). CONCLUSION: We presented compelling evidence of the negative impact of SCD on anthropometric indices of nutritional status of under-five children. Integration of a nutrition-oriented approach into a definitive SCD care package and its nationwide implementation could bring promising results by mitigating the nutritional vulnerability of children with SCD.

Nutritional status and dietary diversity of school-age children living with HIV: a cross-sectional study in Phnom Penh, Cambodia.

BACKGROUND: HIV/AIDS continues to be a major public health concern for children. Each day, worldwide, approximately 440 children became newly infected with HIV, and 270 children died from AIDS-related causes in 2018. Poor nutrition has been associated with accelerated disease progression, and sufficient dietary diversity is considered a key to improve children's nutritional status. Therefore, this study aims to 1) examine nutritional status of school-age children living with HIV in Phnom Penh, Cambodia, and 2) identify factors associated with their nutritional status, especially taking their dietary diversity into consideration. METHODS: This cross-sectional study was conducted in May 2018 within the catchment area of the National Pediatric Hospital, Cambodia. Data from 298 children and their caregivers were included in the analyses. Using semi-structured questionnaires, face-to-face interviews were conducted to collect data regarding sociodemographic characteristics, quality of life, and dietary diversity. To assess children's nutritional status, body weight and height were measured. Viral load and duration of antiretroviral therapy (ART) were collected from clinical records. Multiple logistic regression analyses were performed to identify factors associated with stunting and wasting. RESULTS: Of 298 children, nearly half (46.6%) were stunted, and 13.1% were wasted. The mean number of food groups consumed by the children in the past 24 h was 4.6 out of 7 groups. Factors associated with children's stunting were age (adjusted odds ratio [AOR] 2.166, 95% confidence interval [CI]: 1.151, 4.077), household wealth (AOR 0.543, 95%CI: 0.299, 0.986), duration of receiving ART (AOR 0.510, 95%CI: 0.267, 0.974), and having disease symptoms during the past 1 year (AOR 1.871, 95%CI: 1.005, 3.480). The only factor associated with wasting was being male (AOR 5.304, 95%CI: 2.210, 12.728). CONCLUSIONS: Prevalence of stunting was more than double that of non-infected school-age children living in urban areas in Cambodia. This highlights the importance of conducting nutritional intervention programs, especially tailored for children living with HIV in the country. Although dietary diversity was not significantly associated with children's nutritional status in this study, the findings will contribute to implementing future nutritional interventions more efficiently by indicating children who are most in need of such interventions in Cambodia.

Improving screening for malnourished children at high risk of death: a study of children aged 6-59 months in rural Senegal.

OBJECTIVE: To investigate whether children with concurrent wasting and stunting require therapeutic feeding and to better understand whether multiple diagnostic criteria are needed to identify children with a high risk of death and in need of treatment. DESIGN: Community-based cohort study, following 5751 children through time. Each child was visited up to four times at 6-month intervals. Anthropometric measurements were taken at each visit. Survival was monitored using a demographic surveillance system operating in the study villages. SETTING: Niakhar, a rural area of the Fatick region of central Senegal.ParticipantsChildren aged 6-59 months living in thirty villages in the study area. RESULTS: Weight-for-age Z-score (WAZ) and mid-upper arm circumference (MUAC) were independently associated with near-term mortality. The lowest WAZ threshold that, in combination with MUAC, detected all deaths associated with severe wasting or concurrent wasting and stunting was WAZ <-2·8. Performance for detecting deaths was best when only WAZ and MUAC were used. Additional criteria did not improve performance. Risk ratios for near-term death in children identified using WAZ and MUAC suggest that children identified by WAZ <-2·8 but with MUAC≥115 mm may require lower-intensity treatment than children identified using MUAC <115 mm. CONCLUSIONS: A combination of MUAC and WAZ detected all near-term deaths associated with severe anthropometric deficits including concurrent wasting and stunting. Therapeutic feeding programmes may achieve higher impact if WAZ and MUAC admission criteria are used.

Association between early childhood caries and malnutrition in a sub-urban population in Nigeria.

BACKGROUND: To determine the association between malnutrition and early childhood caries (ECC) in children resident in sub-urban, Nigeria. METHODS: This study was a subset of a larger cross-sectional study the data of which was generated through a household survey conducted in Ile-Ife, Nigeria. The study's explanatory variable was malnutrition (underweight, overweight, wasting and stunting) and the outcome variable was ECC. Poisson regression analysis was used to determine the association between ECC and malnutrition. Variables (sex, frequency of sugar consumption, maternal knowledge of oral hygiene, oral hygiene status) associated with ECC in the primary study were adjusted for to obtain the adjusted prevalence ratio (APR). RESULTS: Of the 370 children, 20 (5.41%) were underweight, 20 (5.41%) were overweight, 67 (18.11%) were wasting, 120 (32.43%) were stunted and 18 (4.86%) had ECC. Factors associated with ECC were being stunted, underweight, overweight and fair oral hygiene. The prevalence of ECC was lower in children who were stunted (APR: 0.14; 95% CI: 0.03-0.69; p = 0.02), almost seven times higher in children who were overweight (APR: 6.88; 95% CI: 1.83-25.85; p < 0.001), and predictively absent in children who were underweight (APR: 0; 95% CI: 0-0; p < 0.001) when compared with children who had normal weight. Non-significant risk indicators for ECC included consuming sugar between meals three times a day or more, having low socioeconomic status and being female. CONCLUSIONS: For this study population, the indicators of malnutrition - being stunted, underweight, overweight - and fair oral hygiene were risk indicators for ECC. The frequency of sugar consumption was not a significant risk indicator when malnutrition was included as an explanatory variable for ECC in the study population.

Prevalence and intensity of Ascaris lumbricoides infections in relation to undernutrition among children in a tea plantation community, Sri Lanka: a cross-sectional study.

BACKGROUND: Ascaris lumbricoides infections are one of the commonnest intestinal nematode infections in the world, with a profound negative effect on nutritional status among underprivileged populations. In Sri Lanka, Ascaris infections and low nutritional status still persist in the plantation sector. However, research regarding the association between Ascaris infections and nutritional status is scarce. The main purpose of this study was to determine the association between Ascaris infections and physical growth among children in a plantation sector in Sri Lanka. METHODS: A cross sectional study was conducted among 489 children aged between 1 and 12 years ina plantation sector, Sri Lanka, from January to April 2013. Anthropometric measurements were collected to assess height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) to determine stunting, underweight and wasting respectively. Data on socio-demographic and antihelminthic treatment were ascertained using an interviewer administrated structured questionnaire. Stool samples were subjected to wet mount preparation followed byformaldehyde-ether sedimentation technique to diagnose Ascaris infection and a Kato Katz technique was performed to determine the eggs intensity. AnthroPlus, EpiInfo and SPSS software was used to analyze data. RESULTS: Of the study sample, 38.4% showed Ascaris lumbricoides infections. Light intensity infections (51%) were common in the infected children, followed by moderate (30%) and heavy (19%) infections. Prevalence of Ascaris infections was significantly associated with de-worming more than six months prior to the study. Prevalence of undernutrition among children was 61.7%. Forty-five per cent were underweight, while 24.1% and 21.5% of children were stunted and wasted respectively. However, no significant association was found between Ascaris infections status and undernutrition. Meanwhile, heavy intensity infections were associated with decreased values of WHZ (p = 0.020). CONCLUSIONS: Ascaris infections and undernutrition are still highly prevalent and a major public health problem in the plantation sector in Sri Lanka. Health and nutrition intervention programs should be implemented to increase the nutritional status of children.

Nutritional Status in Adults with Predialysis Chronic Kidney Disease: KNOW-CKD Study.

Adverse changes in nutrition are prevalent and are strong indicators of adverse outcomes in patients with chronic kidney disease (CKD). The International Society of Renal Nutrition and Metabolism (ISRNM) proposed a common nomenclature and diagnostic criteria to identify protein-energy wasting (PEW) in CKD patients. We examined the nutritional status in 1,834 adults with predialysis CKD enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) study. As there was a need for further understanding of nutritional status and associated factors in CKD, we evaluated the prevalence and associated factors of PEW in adults with predialysis CKD. The prevalence of PEW was about 9.0% according to ISRNM criteria and tended to increase with advanced stage in predialysis CKD. Those who concurrently had PEW, inflammation, and CVD were a small proportion (0.4%). In multivariate logistic regression model, PEW was independently associated with estimated glomerular filtration rate (eGFR) (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99), total CO2 (OR, 0.93; 95% CI, 0.87-0.99), physical activity (OR, 0.43; 95% CI, 0.26-0.69), comorbid diabetes (OR, 1.68; 95% CI, 1.09-2.59), and high sensitivity C-reactive protein (hs-CRP) (OR, 1.03; 95% CI, 1.01-1.06). Our study suggests that PEW increases with advanced CKD stage. PEW is independently associated with renal function, low total CO2, low physical activity, comorbid diabetes, and increased hs-CRP in adults with predialysis CKD.

Insulin ameliorating endotoxaemia-induced muscle wasting is associated with the alteration of hypothalamic neuropeptides and inflammation in rats.

OBJECTIVES: Septic patients always develop muscle wasting, which delays the rehabilitation and contributes to the increased complications and mortality. Previous studies have implied the crucial role of central inflammation and neuropeptides in the energy balance and muscle metabolism. Insulin has been confirmed to attenuate muscle degradation and inhibit inflammation. We tested the hypothesis whether insulin ameliorating muscle wasting was associated with modulating hypothalamic inflammation and neuropeptides. DESIGN AND SUBJECTS: Thirty-two adult male Sprague-Dawley rats were in intraperitoneally injected with lipopolysaccharide (LPS) (5 mg/kg) or saline, followed by subcutaneous injection of insulin (5 IU/kg) or saline. Twenty-four hours after injection, skeletal muscle and hypothalamus tissues were harvested. Muscle wasting was measured by the mRNA expression of two E3 ubiquitin ligases, muscle ring finger 1 (MuRF-1) and muscle atrophy F-box (MAFbx), as well as 3-methylhistidine (3-MH) and tyrosine release. Hypothalamic inflammatory markers and neuropeptides expression were also measured in four groups. RESULTS: LPS injection led to significant increase in hypothalamic inflammation as well as muscle wasting. Also, increased hypothalamic neuropeptides, proopiomelanocortin (POMC), cocaine and amphetamine-related transcript (CART) and neuropeptides Y (NPY) and decreased agouti-related protein (AgRP) were observed. Insulin treatment ameliorated endotoxaemia-induced muscle wasting and hypothalamic inflammation, and attenuated the alteration of neuropeptides, POMC, CART and AgRP. CONCLUSION: Hypothalamic inflammation and neuropeptides are involved in the endotoxaemia-induced muscle wasting. Insulin treatment can reduce muscle wasting, which is associated with reduced hypothalamic inflammation and alteration of hypothalamic neuropeptides.

Nutrition in liver transplantation: too little or too much?

PURPOSE OF REVIEW: The purpose of this study was to review the most recent findings on approaches to managing the obesity and muscle wasting that are found in patients before and after liver transplantation. RECENT FINDINGS: A number of articles have contributed to the accumulating evidence that morbid obesity is not an absolute contraindication to liver transplantation with survival outcomes similar across BMI groups. Obesity is, however, a risk factor for early post-transplant complications and obesity-related comorbidities markedly increase this risk. Very limited data are as yet available, dietary, or otherwise, related to amelioration of these comorbidities and evidence that weight loss leads to improved outcomes in obese patients is lacking. Abdominal computed tomography imaging is increasingly being used to identify muscle wasting, and poorer post-transplant survival is seen in patients with significant muscle wasting. This modality has confirmed the persistence of depleted muscle stores after transplant extending well beyond 1 year. Coupled with this is a high incidence of weight gain and metabolic syndrome and the associated risks. Although dietary intervention and exercise are considered possible approaches to address these issues, work in these areas so far is sparse. SUMMARY: An urgent need exists for interventional studies on the basis of nutrition and/or exercise to address the challenges presented by both obesity and muscle wasting, which likely coexist in many patients in both the pretransplant and the post-transplant periods.

Update on inflammation in chronic kidney disease.

BACKGROUND: Despite recent advances in chronic kidney disease (CKD) and end-stage renal disease (ESRD) management, morbidity and mortality in this population remain exceptionally high. Persistent, low-grade inflammation has been recognized as an important component of CKD, playing a unique role in its pathophysiology and being accountable in part for cardiovascular and all-cause mortality, as well as contributing to the development of protein-energy wasting. SUMMARY: The variety of factors contribute to chronic inflammatory status in CKD, including increased production and decreased clearance of pro-inflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, including those related to dialysis access, altered metabolism of adipose tissue, and intestinal dysbiosis. Inflammation directly correlates with the glomerular filtration rate (GFR) in CKD and culminates in dialysis patients, where extracorporeal factors, such as impurities in dialysis water, microbiological quality of the dialysate, and bioincompatible factors in the dialysis circuit play an additional role. Genetic and epigenetic influences contributing to inflammatory activation in CKD are currently being intensively investigated. A number of interventions have been proposed to target inflammation in CKD, including lifestyle modifications, pharmacological agents, and optimization of dialysis. Importantly, some of these therapies have been recently tested in randomized controlled trials. KEY MESSAGES: Chronic inflammation should be regarded as a common comorbid condition in CKD and especially in dialysis patients. A number of interventions have been proven to be safe and effective in well-designed clinical studies. This includes such inexpensive approaches as modification of physical activity and dietary supplementation. Further investigations are needed to evaluate the effects of these interventions on hard outcomes, as well as to better understand the role of inflammation in selected CKD populations (e.g., in children).

Gendered effects of siblings on child malnutrition in South Asia: cross-sectional analysis of demographic and health surveys from Bangladesh, India, and Nepal.

This study examines the effects of number and sex of siblings on malnutrition of boys and girls under-5 in South Asia. Cross-sectional analyses were conducted on Demographic and Health Surveys data on children under-5 in Bangladesh (N = 7,861), India (N = 46,655) and Nepal (N = 2,475). Data were pooled across countries, and multinomial logistic regression was used to assess the relationship between number and sex of siblings and malnutrition outcomes (wasting, stunting, underweight; based on anthropometric data), adjusting for country and key social and maternal-child health indicators in sex stratified analyses. Number of brothers increased the odds for severe wasting [1 vs. 0 brothers adjusted odds ratio (AOR) = 1.31, 95 % CI = 1.11, 1.55; 2 vs. 0 brothers AOR = 1.36, 95 % CI = 1.07, 1.73] for girls but not boys. Having more male siblings and more female siblings increased the odds of stunting for boys and girls, but effect of 3+ sisters on severe stunting was significantly stronger for girls than boys (girls- 3+ vs. 0 sisters AOR = 2.25, 95 % CI = 1.88, 2.70; boys- 3+ vs. 0 sisters AOR = 1.37, 95 % CI = 1.13, 1.67). For underweight, three or more sisters increased the odds for severe underweight for girls (AOR = 1.27, 95 % CI = 1.04, 1.57) but not boys. Having brothers heightens girl risk for acute malnutrition (wasting), where having multiple sisters increases girl risk for chronic malnutrition (stunting/underweight). Boy malnutrition is less affected by siblings. Findings suggest that issues of son preference/daughter aversion may affect child malnutrition in South Asia.

The nutritional status of patients starting specialized predialysis care.

OBJECTIVE: To examine the prevalence of and risk factors for malnutrition at the start of specialized predialysis care. DESIGN: The present analysis was performed on cross-sectional data collected at inclusion in the study. The study included 25 outpatient clinics delivering specialized predialysis care in the Netherlands. SUBJECTS: Three hundred seventy-six incident patients with advanced chronic kidney disease attending one of the participating outpatient clinics. MAIN OUTCOME MEASURE: Subjective global assessment (SGA) of nutritional status. RESULTS: At the start of specialized predialysis care, 11% of patients suffer from moderate protein-energy wasting as measured by SGA. Independent risk factors are age >75 years (Odds ratio [OR], 3.88 [1.74-8.66]), female gender (OR, 2.95 [1.37-6.32]), and having a body mass index <25 kg/m(2) (OR, 2.56 [1.19-5.49]). Estimated glomerular filtration rate was not significantly associated with SGA (OR, 1.63 [0.76-3.48]). CONCLUSIONS: Eleven percent of patients started on specialized predialysis care suffer from moderate protein-energy wasting; risk factors are age >75 years, female gender, and BMI <25 kg/m(2).

Angiotensin II inhibits satellite cell proliferation and prevents skeletal muscle regeneration.

Cachexia is a serious complication of many chronic diseases, such as congestive heart failure (CHF) and chronic kidney disease (CKD). Although patients with advanced CHF or CKD often have increased angiotensin II (Ang II) levels and cachexia and Ang II causes skeletal muscle wasting in rodents, the potential effects of Ang II on muscle regeneration are unknown. Muscle regeneration is highly dependent on the ability of a pool of muscle stem cells (satellite cells) to proliferate and to repair damaged myofibers or form new myofibers. Here we show that Ang II reduced skeletal muscle regeneration via inhibition of satellite cell (SC) proliferation. Ang II reduced the number of regenerating myofibers and decreased expression of SC proliferation/differentiation markers (MyoD, myogenin, and active-Notch) after cardiotoxin-induced muscle injury in vivo and in SCs cultured in vitro. Ang II depleted the basal pool of SCs, as detected in Myf5(nLacZ/+) mice and by FACS sorting, and this effect was inhibited by Ang II AT1 receptor (AT1R) blockade and in AT1aR-null mice. AT1R was highly expressed in SCs, and Notch activation abrogated the AT1R-mediated antiproliferative effect of Ang II in cultured SCs. In mice that developed CHF postmyocardial infarction, there was skeletal muscle wasting and reduced SC numbers that were inhibited by AT1R blockade. Ang II inhibition of skeletal muscle regeneration via AT1 receptor-dependent suppression of SC Notch and MyoD signaling and proliferation is likely to play an important role in mechanisms leading to cachexia in chronic disease states such as CHF and CKD.

Autophagic degradation contributes to muscle wasting in cancer cachexia.

Muscle protein wasting in cancer cachexia is a critical problem. The underlying mechanisms are still unclear, although the ubiquitin-proteasome system has been involved in the degradation of bulk myofibrillar proteins. The present work has been aimed to investigate whether autophagic degradation also plays a role in the onset of muscle depletion in cancer-bearing animals and in glucocorticoid-induced atrophy and sarcopenia of aging. The results show that autophagy is induced in muscle in three different models of cancer cachexia and in glucocorticoid-treated mice. In contrast, autophagic degradation in the muscle of sarcopenic animals is impaired but can be reactivated by calorie restriction. These results further demonstrate that different mechanisms are involved in pathologic muscle wasting and that autophagy, either excessive or defective, contributes to the complicated network that leads to muscle atrophy. In this regard, particularly intriguing is the observation that in cancer hosts and tumor necrosis factor α-treated C2C12 myotubes, insulin can only partially blunt autophagy induction. This finding suggests that autophagy is triggered through mechanisms that cannot be circumvented by using classic upstream modulators, prompting us to identify more effective approaches to target this proteolytic system.

Reactive oxygen species play a role in muscle wasting during thyrotoxicosis.

The role of reactive oxygen species (ROS) in muscle protein hydrolysis and protein oxidation in thyrotoxicosis has not been explored. This study indicates that ROS play a role in skeletal muscle wasting pathways in thyrotoxicosis. Two experimental groups (rats) were treated for 5 days with either 3,3',5-triiodothyronine (HT) or HT with α-tocopherol (HT + αT). Two controls were used, vehicle (Control) and control treated with αT (Control + αT). Serum T3, peritoneal fat, serum glycerol, muscle and body weight, temperature, mitochondrial metabolism (cytochrome c oxidase activity), oxidative stress parameters and proteolytic activities were examined. High body temperature induced by HT returned to normal when animals were treated with αT, although total body and muscle weight did not. An increase in lipolysis was observed in the HT + αT group, as peritoneal fat decreased significantly together with an increase in serum glycerol. GSH, GSSG and total radical-trapping antioxidant parameter (TRAP) decreased and catalase activity increased in the HT group. The glutathione redox ratio was higher in HT + αT than in both HT and Control + αT groups. Carbonyl proteins, AOPP, mitochondrial and chymotrypsin-like proteolytic activities were higher in the HT group than in the Control. HT treatment with αT restored mitochondrial metabolism, TRAP, carbonyl protein, chymotrypsin-like activity and AOPP to the level as that of the Control + αT. Calpain activity was lower in the HT + αT group than in HT and Control + αT and superoxide dismutase (SOD) activity was higher in the HT + αT group than in the Control + αT. Although αT did not reverse muscle loss, ROS was involved in proteolysis to some degree.

Stunting and wasting are associated with poorer psychomotor and mental development in HIV-exposed Tanzanian infants.

Infants born to HIV-infected women are at increased risk of impaired neurodevelopment, but little research has attempted to identify modifiable risk factors. The objective of this prospective cohort analysis was to identify maternal, socioeconomic, and child correlates of psychomotor and mental development in the first 18 mo of life among Tanzanian infants born to HIV-infected women. We hypothesized that child HIV infection, morbidity, and undernutrition would be associated with lower developmental status when taking into consideration maternal health and socioeconomic factors. Baseline maternal characteristics were recorded during pregnancy, birth characteristics were collected immediately after delivery, infant micronutrient status was measured at 6 wk and 6 mo, and anthropometric measurements and morbidity histories were performed at monthly follow-up visits. The Psychomotor Development Index (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Development, 2nd edition (BSID-II) were used to assess developmental functioning at 6, 12, and 18 mo of age. Multivariate repeated regression models with time-varying covariates were used to estimate adjusted mean MDI and PDI scores for each level of the variables. A total of 311 infants contributed ≥1 BSID-II assessments for 657 PDI and 655 MDI measurements. Of infants, 51% were male, 23% were born preterm, 7% were low birth weight, and 10% were HIV-positive at 6 wk. Preterm birth, child HIV infection, stunting, and wasting were independently associated with lower PDI and MDI scores. Strategies to lower mother-to-child transmission of HIV, prevent preterm birth, and enhance child growth could contribute to improved child psychomotor and mental development.

Progressive development of melanoma-induced cachexia differentially impacts organ systems in mice.

Cachexia is a systemic wasting syndrome that increases cancer-associated mortality. How cachexia progressively and differentially impacts distinct tissues is largely unknown. Here, we find that the heart and skeletal muscle undergo wasting at early stages and are the tissues transcriptionally most impacted by cachexia. We also identify general and organ-specific transcriptional changes that indicate functional derangement by cachexia even in tissues that do not undergo wasting, such as the brain. Secreted factors constitute a top category of cancer-regulated genes in host tissues, and these changes include upregulation of the angiotensin-converting enzyme (ACE). ACE inhibition with the drug lisinopril improves muscle force and partially impedes cachexia-induced transcriptional changes, although wasting is not prevented, suggesting that cancer-induced host-secreted factors can regulate tissue function during cachexia. Altogether, by defining prevalent and temporal and tissue-specific responses to cachexia, this resource highlights biomarkers and possible targets for general and tissue-tailored anti-cachexia therapies.

Effects of armed conflicts on childhood undernutrition in Africa: a systematic review and meta-analysis.

BACKGROUND: Undernutrition is defined as not consuming enough nutrients and energy to meet one's needs for maintaining good health. It is exacerbated by armed conflict. Individuals cannot stick to jobs because of a lack of safety during conflicts, which has an impact on families' ability to purchase food. However, there is a paucity of evidence on pooled evidence on the impact of armed conflict on childhood undernutrition among children aged 6 to 59 months in Africa. Therefore, this review aimed to examine the effects of armed conflict on the magnitude of undernutrition, particularly stunting, underweight, and wasting among children in Africa. METHODS: A comprehensive literature search was conducted using electronic databases (PubMed, Hinari, and Google Scholar database) to locate potential studies. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics. Small-study effects were checked using Egger's statistical test at a 5% significance level. A random-effects model was employed to estimate the pooled prevalence and associated factors of undernutrition among children aged 6-59 months in Africa. RESULTS: Of a total of 585 articles retrieved from the databases, 12 studies met our inclusion criteria. The pooled prevalence of wasting, stunting, and being underweight among conflict-affected African countries was 20.25% (95%CI = 15.08-25.43), 34.18% (95% CI = 26.34-42.02), and 24.00% (95%CI = 16.35-31.65), respectively. The most consistent factors associated with childhood stunting, wasting, and being underweight in Africa were low mother's education, prolonged duration of armed conflict, and rural place of residence. CONCLUSION: The severity of malnutrition crises will be assisted by a better understanding of the variables associated with child malnutrition, which will improve the effectiveness of development and humanitarian responses. We urge that health planners, policymakers, and the general public prioritize children with acute malnutrition in Africa's conflict-affected areas. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022367487.

Wasting is associated with stunting in early childhood.

The longitudinal relationship between stunting and wasting in children is poorly characterized. Instances of wasting or poor weight gain may precede linear growth retardation. We analyzed longitudinal anthropometric data for 1599 children from 8 cohort studies to determine the effect of wasting [weight-for-length Z-score (WLZ) < -2] and variability in WLZ in the first 17 mo on length-for-age Z-score (LAZ) at 18-24 mo of age. In addition, we considered the effects of change in WLZ during the previous 6-mo period on length at 18 and 24 mo. Wasting at 6-11 or 12-17 mo was associated with decreased LAZ; however, children who experienced wasting only at 0-5 mo did not suffer any long-term growth deficits compared with children with no wasting during any period. Children with greater WLZ variability (≥0.5 SD) in the first 17 mo of life were shorter [LAZ = -0.51 SD (95% CI: -0.67, -0.36 SD)] at 18-24 mo of age than children with WLZ variability <0.5. Change in WLZ in the previous 6-mo period was directly associated with greater attained length at 18 mo [0.33 cm (95% CI: 0.11, 0.54 cm)] and 24 mo [0.72 cm (95% CI: 0.52, 0.92 cm)]. Children with wasting, highly variable WLZ, or negative changes in WLZ are at a higher risk for linear growth retardation, although instances of wasting may not be the primary cause of stunting in developing countries.